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Submitted by Dr. Yasser Mokhtar, MD. Critical Care Medicine fellow, University of Pittsburgh Medical Center.

Sunday, 29th February 2004


American Heart Association outlined the first guidelines for women to combat and prevent cardiovascular disease


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Myocardial infarction review

Until now, women had to rely on prevention and treatment guidelines for coronary heart disease based on research on men.

This month, the American Heart Association outlined measures for women to combat and prevent cardiovascular disease, the first evidence-based guidelines for women.

Coronary heart disease (CHD) is often fatal, and because nearly two thirds of women who die suddenly have no previously recognized symptoms, it is thus essential to prevent CHD. AHA figures show that about half a million women die of heart disease and strokes each year, killing more than the next seven causes of death combined, including cancer.

In comparisons between the genders, WomenHeart, the National Coalition for Women with Heart Disease, says that women are more likely than men to die within one year of a heart attack; women are twice as likely as men to die after a bypass; and 35 percent of female and 18 percent of male heart attack survivors will have a recurrent heart attack within six years.

Risk factors for cardiovascular disease in both men and women include high cholesterol and blood pressure, smoking, not exercising, obesity, stress and a family history of heart disease and stroke.

TABLE 1. Spectrum of CVD Risk in Women

  Risk Group

Framingham Global Risk
(10-y Absolute CHD Risk)

Clinical Examples

  High risk > 20%
  Intermediate risk 10% to 20%
  • Subclinical CVD (eg, coronary calcification)
  • Metabolic syndrome
  • Multiple risk factors
  • Markedly elevated levels of a single risk factor
  • First-degree relative(s) with early-onset (age: 55 y in men and 65 y in women) atherosclerotic CVD
  Lower risk <10%
  • May include women with multiple risk factors, metabolic syndrome, or 1 or no risk factors
  Optimal risk <10%
  • Optimal levels of risk factors and heart-healthy lifestyle

CHD indicates coronary heart disease; CVD, cardiovascular disease.
Most women with a single, severe risk factor will have a 10-year risk 10%.

Women with a 10 percent or less risk of having a heart attack in the next 10 years are considered low risk; those with a 10 percent to 20 percent chance are intermediate-risk, and those with a 20 percent or higher chance are high-risk.

The new prevention guidelines aimed at women urge at least 30 minutes of moderate physical activity most days; quitting smoking; and that high-risk women receive cholesterol-lowering drugs, preferably statins, and take omega 3 and folic acid supplements.

Also included are some guidelines of what not to do. The AHA says doctors should not recommend hormone replacement therapy, once thought to increase heart health. In recent years, however, HRT has come under fire for increasing the risk for a number of diseases including cancer.

The routine use of aspirin in lower-risk women was also discouraged but encouraged in high-risk women. The guidelines are published in the AHA's Circulation journal.


pdf_icon.jpg (13x13 -- 0 bytes) Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women
pdf_icon.jpg (13x13 -- 0 bytes) Tracking Women?s Awareness of Heart Disease, an American Heart Association National Study

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